April 21, 2006

“How does one continue to sacrifice when some big shots are growing fat on the spoils; the Government, the Mission - all corrupt!Sacrifice will only bear fruits when it is participatory; you sacrifice, I sacrifice." Dr. Valentine Ngwa.

Shortly after he obtained his medical degree from the University of Benin in Nigeria, Dr. Valentine Ngwa returned home to practice medicine. Then some six years later, he packed his bags for Britain where he now resides. In this interview Dr. Ngwa candidly explains why he originally went back to work in Cameroon, why he ultimately sought greener pastures abroad, and what it would take to bring him back to Cameroon:

Q. After graduating from the University of Benin Medical School in Nigeria in 1997, you decided to return home rather than go to Europe or America to practice medicine. Why?

After graduation, I worked in Nigeria up till 1999. During this time, I wrote the International English Language exam, which is required for doctors wishing to sit for the UK Medical Board exam, applied for the Uk’s Medical board exam PLAB and was supposed to write the first part in November 1999 in London.

My initial intention of returning home was just to get a few months of leisure, then go to the UK. However, a lot of things changed when I came into contact with the health reality in Cameroon after visiting my nephew in hospital. The poor state of the delivery system made me change plans as I realized that I would be making a big mistake if I leave Cameroon without knowing fully well how its health system operates and possibly join the fight to improve it.

Q. You ended up with the Catholic Hospital in Njinikom. Was this a deliberate choice or due to problems getting integrated into the Public Service?

At the time I decided to stay in Cameroon, the public service was not recruiting those of us from abroad; the mission hospitals were. I wanted a place where I could render service; Njinikom seemed the best option. However, one wonders deeply why the Government fails to employ doctors who come back home, yet turn around and complain of a shortage of doctors.

Q. Three and a half years later, you had risen to the position of Chief Medical Officer at the hospital. Then suddenly you packed your bags for a job in Britain… How do you explain this rather drastic move at that point in your career, which seemed to be going on just fine?

Being a Chief Medical Officer of a Catholic General Hospital was not my idea of the zenith in my career. Medicine is an international profession, and we strive to get the type of training and experience whereby we could interact with our peers the world over without a complex. The type of training and experience we got, though extensive, was not quantifiable; this is dangerous because you risk being seen as someone with just a primary medical qualification. I wanted the type of training and experience that will be acceptable to sane medical bodies as true career progression. Unfortunately, Cameroon couldn’t give me that.

Also, one needs to think of his welfare and that of his family. We are all entitled to a better life. And it is important that we do not do wrong things in order to attain this better life.

We practically had no life, as we put in all our efforts in the hospital. We did our calls weekly, which means for a whole 7 days, a doctor stays inside the hospital premises, works under appalling conditions, sees patients in horrible conditions, socializes far less than his other friends and so on. At the end of it, the take-home is pitiable.

So it was obvious that this has to come to an end one day, as there are also other important things in life.

Q. Looking back, do you regret your three and a half-year stint in Cameroon, and do you consider these as wasted years?

Not at all! That was the most challenging period of my career, but it, nonetheless, gave me an opportunity to know in detail who my people are, their understanding of ill-health, and their response to it. These are issues you rarely read in books. I came face to face with the realities that cause my people die on daily basis. This reality, some of which are very frightful, is worth experiencing – the true baptism of fire; so how could I have wasted those years?

Q. Do you feel any sense of guilt for leaving Cameroon with all your skills and knowledge (particularly those related to HIV prevention and management) at a time when your country needed you most?

Yes ... at times I do feel guilty. Our work on HIV and other aspects had brought us closer to many people who looked up to us; you do create bonds with your patients, especially when it concerns matters of life and death. But, I also ask myself what other options I had. It is quite difficult to persevere, stay at home and take all the crap from administrators when rich nations are willing to engage your services with far more reasonable offers.

Q. Some have argued that those professionals, particularly in the health field, who leave Cameroon for greener pastures overseas lack the patriotic fervor and sense for sacrifice required to build a prosperous nation. How do you respond to this accusation?

What a simplistic way to explain a complex problem.

The pursuit of happiness is everyone’s inalienable rights and it will be good to know the patriotism scale that has been used to classify this pursuit as unpatriotic.

Look, for someone to undertake six years of hard work, buying very expensive books and equipment just to graduate and earn the crap salary being paid, work in horrible conditions, take insults from semi-illiterates and can’t afford the good things of life is more patriotic than we think, even if he/she works for just six months!

By the way, how does one continue to sacrifice when some big shots are growing fat on the spoils; the government, the mission - all corrupt! Sacrifice will only bear fruits when it is participatory; you sacrifice, I sacrifice. But when I do and some sit up there and embezzle everything, then it all comes to waste!!

These people who think we are unpatriotic will be the same ones laughing in our faces when we move around in tattered clothes and shoes due to our poor financial state. We might have signed to save lives, but we surely never signed for a life of misery. If anyone considers our efforts at developing ourselves as being unpatriotic, then so be it.

Q. What is the single most significant difference between practicing medicine in Cameroon and in England?

Medicine in England is a job; you have a job description, do it and get paid. However, medicine in Cameroon is more of a calling; you do everything, and don’t think so much about the money!

Q. So what is the bottom line? Is the health care problem in Cameroon a systemic one or one of the misallocation or unavailability of human resources?

I think it is all combined. The cracks started appearing with the unavailability of funds; and this was primarily as a result of serious misallocation of the funds. This led to the serious lapses in the system to become obvious, and things started crumbling. The unavailability of human resources is just a consequence of the above.

Q. What will be your advice to all those young Cameroonians in foreign Medical Schools? Should they return home after their training, in spite of the challenges you’ve discussed, or should they stay put?

Someone cannot call himself a Cameroonian if he or she doesn’t know Cameroon. Similarly, a Cameroonian doctor cannot call himself one if he or she doesn’t know the Cameroon Health system. I will always encourage them to spend some time in the service of Cameroon; for their personal development and the good of the nation’s healthcare. At the end of the day, they will get a certain level of experience that will hardly be obtained in the structured teaching hospitals abroad.

I think there is great pride in serving your country.

However, I will also not hesitate to warn them to keep their return tickets, just in case... Cameroon is unpredictable.

Q. Finally, what will it take for you to return home, or at least consider returning home, and pick up from where you left off?

Though still attached to some health programs back home, I am hoping to make periodic short trips as a volunteer. However, I will consider returning home permanently when Cameroon gets itself out of this mess or at least makes the effort; and the only thing holding it in this mess is the high level of institutionalized corruption. Cameroon is not a poor nation!

I will be more than happy to give my expertise to my country -- even if the remuneration is nothing to write home about -- as long as we all are sacrificing. It surely will be comforting knowing that one is laying the foundation for future generations. However, if some people have to do the work while others take the benefits, then it all boils down to a scenario of trying to carry water in a basket; a total waste of effort...

Though, I will love very much to work in Cameroon again, I will have no regrets if I never have to, due to the prevailing situation.

About Dr. Valentine NgwaDr Valentine Ngwa currently works with the Clinical Oncology Department of Leeds Teaching Hospitals NHS trust where he has been since 2003. He graduated From the University of Benin Medical School, Nigeria in 1997.

He worked at the Central Hospital Benin-City, Nigeria up until 1999 when he joined the Catholic Mission General Hospital Njinikom. He worked athe Njinikom Hospital until March 2003. During his time at Njinikom, he held a number of vital positions, prominent among them;

Head of TB treatment and control program in the Catholic Health service of the arch-diocese of Bamenda.

Head of HIV treatment and care in the Catholic Health service of the arch-diocese of Bamenda.

Chief medical Officer Njinikom Catholic Hospital

Dr Ngwa is a Co-founder of Intercare-Njinikom Project Hope, a hospital based NGO and was program officer for its Mother-to-child transmission prevention arm and its HIV palliative care arm.

Dr. Ngwa can be heard live this Friday, April 21, 2006 from 7pm-10pm London time (2-5pm Washington time) on Cameroon Rendezvous which is broadcast on the Voice of Africa Radio in London. The discussion will focus on the Cameroon health system.

Doc,I am not a medic but from your interview, I clearly see that the pinch that other able men and women too from differnt walks of life can't bear the pains by sitting here in Cameroon working for others to enjoy. It is but human that when the going is good, we stay and when issues turn to go off-hand, we quit.
that is Camerron and that is how some of our elders if not all of them have designed it to be.
Untill the rotten tooth that is plagueing our society is pulled off, our currupt system will continue to widen the doors of brain draining in this drowning 'Land of Promise' of ours.
Doc and all in the diaspora, keep the faith. One day, One fine day, the tables will turn and our people will be glad to welcome you back home.

Doc more grease. You just touched the tip of the iceberg. Nobody will know what it looks like until you try your skill back home and see how an equivalent of your house boy feeds on the spoils. If the missions are also corrupt, then who will save Cameroon? Hope you did not sign Med. Certs for 2000 XAf.

Now lets interview some of the folks who are doing exceedingly well in that system. How on earth can a doctor be worse off than a policeman? Doctors with ability like this one have no choice but to leave. The other time, it was the Prime Minister who was calling people like this doctor unpatriotic. Let the Prime Minister declare all his assets!

good piece valy. interesting debate by self serving politicians who get their kids abroad on the first available flight out of cameroon, and try to reflect our collective failure as a people,masterminded by their greed and an embarassing interpretation of government, on people like us who are just a pound in their irresponsible actions.they should be men and women enough to accept responsibility for what is now cameroon."who the cap fits, let him wear it".calling medical doctors and other educated cameroonians who flee the country for better opportunities unpatriotic is just an other way of shifting blames to others.as cameroonian leaders and individuals i believe in their most private of moments they feel really sorry for what they have done to one country.we atleast get more decent post graduate training abroad, earn a decent living and repatriate funds back home to support families,friends and projects back home.they spend their lots on God knows what.personaly i am comfortable with my decision to leave cameroon and practice medicine abroad and talking to colleagues in the 'states' where i am based,one hardly see any sign of frustration.We all desperately hope to contribute in some form to the health of our people at home but it is annoying when politicians who got us to where we are as a people and can not seem to ever get their acts together go on air and critisize honest, hard working and decent people for their cheap political gains.

I absolutely appreciate the situations that prompt our medical doctors and other professionals to leave cameroon. Many have left and many are still leaving. Some are fortunate like Dr Ngwa to make it and others end up working as loaders or carers in homes or even cleaners abroad cos the system is difficult to intergrate in. however, that is not my concern here. Yes, our cameroonian system is crap and 'monkey di work baboon di chop'. We leave cos we need to make things better especially for ourselves and our family. But then, one thing keeps worrying me. We are leaving behind our families and friends who equally need our services, and the absence of these services means the system will keep degenerating. we will say as individuals we will not solve these problems. But I do think collectively we can. Staying abroad and keeping away from the problem does not solve them. i think we should look for alternative means of solving the problems of our country rather than run away from them. we hope these corrupt people go away. how do they go away when we are out here, and are doing nothing about it except fend for ourselves instead of contributing positively to our country by actively being present there and doing these things?

In a nutshell,all that is wrong with Cameroon comes out in a single' very eloquent peace by one person. There is nothing to add, except something that caught my attention.Some of the impositons place on borrowing nations by the IMF are very inhumane. Putting a total blanket on hiring with no regards to critical profesions such as medicine is unwarranted.Maybe Dr. Ngwa would have stayed in Cameroon had the government hired him. But knowing our Country, he probably would never have been hired either.
So Doc., keep doing what you are doing. Help when you can, but safeguard your interest first.

"Medicine in England is a job; you have a job description, do it and get paid. However, medicine in Cameroon is more of a calling; you do everything, and don’t think so much about the money!" Shocking to hear that from you doc. Do you mean your calling has been thrown to the pigs in Cameroon?